Shortly after my recent post, “How the Backlash to Oregon’s Plan to Taper Opioids with Integrative Approaches Missed the Mark”, I received an e-note from national pain leader Sean Mackey, MD, PhD. The letterhead of the chief of the division of pain medicine at Stanford University and co-chair of the US HHS National Pain Strategy was the vehicle through which Mackey and 100 co-signers successfully campaigned for the Oregon Health Authority to prevent forced tapering “of certain patient populations.” Mackey wrote that he presumed we had shared interests in bettering care, yet he thought there was a harmful “negativity” in my article: “May I suggest rather than a ‘missed opportunity’ message, you could easily frame it as ‘forced opioid tapering defeated – here is what we need to do next …'”
On May 7-10, 2019, I attended the top international integrative health research conference that comes around each year. The 14th International Congress on Complementary Medicine Research drew roughly 400 “delegates” as the Brisbane, Australia hosts welcomed us. We hailed from 34 nations. The turnout to the distant location was about half that when the meeting is hosted in North America or Europe and roughly on par with a 2015 South Korean event. Yet despite or perhaps because of the size and distance new themes emerged and old ones that needed prodding re-emerged. Together these offer an impactful direction for the global integrative research community and for ISCMR, the organization of traditional, complementary and integrative medicine researchers that co-sponsors each of these event.
In the United States, the complementary and integrative medicine dialogue about “traditional medicine” typically looks to Asia. The West-meets-East orientation respects the power and influence of Chinese and Indian traditions. Yet in doing so, both local indigenous practices and the roles of traditional, complementary and integrative medicine (TCIM) in Mexico, Central America, South America and the Caribbean are mostly overlooked. The Pan American Health Organization (PAHO) recently created a partial remedy for this hemispheric forgetfulness. A two-year collaborative process with representatives of over 20 nations has created a powerful network and opened access to a nation-by-nation bounty of practices, papers, research, and regulations.
When Oregon announced in 2016 that it would shift its back and neck care for Medicaid clients from opioids toward acupuncture, spinal manipulation, massage, yoga therapy and mind-body methods, it was heralded as a breakthrough for pain treatment nationally. Inside that policy was a mandate many now consider even bigger news. Doctors were required to totally taper patients off opioids. A backlash propelled by a letter signed by over 100 conventional pain academics nationwide – plus with one notable signer from the integrative pain community – stopped Oregon’s planned expansion of the model in its tracks. While there are good reasons for caution on mandatory tapering, the one-sided reactivity missed a chance for practitioners and patients alike to gain more experience with non pharmacologic tools to rein in the known abuses associated with opioids.